- Author: Leandro Feo, MD; Chief Editor: Vikram Kate, MBBS, PhD, MS, FRCS, FRCS(Edin), FRCS(Glasg), FACS, FACG, FIMSA, MAMS, MASCRS more...
Rectal prolapse is a debilitating condition that affects 1% of people older than 60 years. Surgical approaches to its treatment include a perineal approach and an abdominal approach. Laparoscopic rectopexy was initially described in the early 1990s and has since become the abdominal procedure of choice for rectal prolapse. This review describes three of the current laparoscopic approaches in the management of rectal prolapse and rectocele.
Once rectal prolapse is diagnosed, surgical repair is indicated to prevent worsening fecal incontinence and discomfort.
Abdominal rectopexy yields low recurrence rates (< 5%) and some improvement of incontinence. However, this approach can cause constipation and does not resolve existing constipation,[3, 4] possibly owing to rectal denervation after the posterolateral dissection of the rectum.
In contrast, perineal approaches, including Altemeier and Delorme procedures, are associated with a higher recurrence rate but lower morbidity than open abdominal approaches. Although considered safer operations, with the rate of recurrence approaching 18% and minimal improvement in continence, better alternatives have been investigated.
The small incisions, lack of anastomosis, and low recurrence rates of the minimally invasive approach have reduced the morbidity of the abdominal approach without affecting efficacy. In a randomized control trial, laparoscopic rectopexy had fewer complications, shorter length of hospital stay, and decreased in pain compared with open abdominal rectopexy. In addition, the morbidity was comparable to perineal procedures.
Compared with the classic open posterior rectopexy, laparoscopic rectopexy has similar functional outcomes regarding constipation. Satisfactory long-term results have been reported with laparoscopic "ventral" rectopexy, and new constipation is prevented because of the lack of posterior dissection.[6, 7, 8, 9]
Compared with laparoscopic rectopexy, results of robotic rectopexy are similar in terms of length of stay, postoperative pain, recurrence, and mortality rates. In contrast, robotic rectopexy is associated with a longer operative time and higher costs.[10, 11, 12]
Stein EA. Stein DE. Rectal Procidentia: Diagnosis and Management. Gastrointestinal Endoscopy Clinics of North America. 2006. 16:189-201.
Berman IR. Sutureless laparoscopic rectopexy for procidentia: technique and implications. Dis Colon Rectum. 1992. 35:689-693.
Brazzelli M, Bachho P, Grant A. Surgery for complete rectal prolapse in adults. Syst Rev. 2000. 2:CD001758. [Full Text].
Madiba TE, Baig MK, Wexner SD. Surgical management of rectal prolapse. Arch Surg. 2005. 140:63–73.
Solomon MJ, Young CJ, Eyers AA, Roberts RA. Randomized clinical trial of laparoscopic versus open abdominal rectopexy for rectal prolapse. Br J Surg. 2002. 89:35–9.
D’Hoore A, Cadoni R, Penninckx F. Laparoscopic ventral rectopexy for total rectal prolapse: long-term outcome. Br J Surg. 2004. 91:1500–5.
Boons, P., Collinson, R., Cunningham, C. and Lindsey, et al. Laparoscopic ventral rectopexy for external rectal prolapse improves constipation and avoids de novo constipation. Colorectal Disease. 2010. 12:526–532.
Bjerke T, Mynster T. Laparoscopic ventral rectopexy in an elderly population with external rectal prolapse: clinical and anal manometric results. Int J Colorectal Dis. 2014 Jul 18. [Medline].
Maeda Y, Vaizey CJ, Warusavitarne J. Response to consensus on ventral rectopexy: report of a panel of experts. Colorectal Dis. 2014 Jun 24. [Medline].
Wong MT, Meurette G, Rigaud J, Regenet N, Lehur PA. Robotic versus laparoscopic rectopexy for complex rectocele: a prospective comparison of short-term outcomes. Dis Colon Rectum. 2011. 54 (3):342-6.
Heemskerk J, de Hoog DE, van Gemert WG, Baeten CG, Greve JW, Bouvy ND. Robot-assisted vs. conventional laparoscopic rectopexy for rectal prolapse: a comparative study on costs and time. Dis Colon Rectum. 2007. 50(11):1825-30.
Mehmood RK, Parker J, Bhuvimanian L, Qasem E, Mohammed AA, Zeeshan M, et al. Short-term outcome of laparoscopic versus robotic ventral mesh rectopexy for full-thickness rectal prolapse. Is robotic superior?. Int J Colorectal Dis. 2014 Jun 26. [Medline].
Munz Y, Moorthy K, Kudchadkar R, Hernandez JD, Martin S, Darzi A, et al. Robotic assisted rectopexy. Am J Surg. 2004. 187 (1):88-92.
Richelle J, Felt B,Tiersma S, Cuesta M. Rectal Prolapse, Rectal intussusception, Rectocele, Solitary rectal Ulcer Syndrome and enterocele. Gastroenterology Clin N Am. 2008. 37:645–668.
Wong M, Meurette G, Abet E, Podevin J, Lehur PA. Safety and efficacy of Laparoscopic ventral mesh rectopexy for complex Rectocele. Colorectal Dis. 2010. [Full Text].